Clinicopathologic and molecular characteristics of Chinese lung adenocarcinoma patients with exon 20 insertion mutations.

Background: Epidermal growth factor receptor exon 20 insertions ( ex20ins) occur in about 4-14% of lung adenocarcinoma (LUAD) patients with mutations. Recently some targeted drugs have been approved for the treatment of LUAD patients with ex20ins. However, the heterogeneity of ex20ins mutations and resultant challenges in identifying them have led to the underestimation of their frequency.

Methods: We investigated the molecular and clinicopathologic features of ex20ins in 3,892 Chinese LUAD patients using next-generation sequencing (NGS). The frequency and distribution of ex20ins mutations between Chinese and Western LUAD patients were also compared by integrating the data of this study and the data of previous studies.

Results: A total of 23 unique ex20ins were identified in 77 LUAD patients, accounting for 1.98% of all LUAD patients and 3.49% of mutant LUDA patients. The 2 most common ex20ins subtypes were S768_D770dup and A767_V769dup, which together accounted for 55.84% of the ex20ins cases. About 61% (14/23) of the ex20ins subtypes occurred only once. Additionally, 8 of the ex20ins subtypes were not recorded in the COSMIC database. These results showed that the ex20ins mutations were highly heterogeneous. There was no significant difference in the frequency and distribution of ex20ins mutations between Chinese and Western LUAD patients, but the frequency of ex20ins mutations was significantly lower in -mutant Chinese LUAD patients than Western LUAD patients. The co-mutation analysis showed that ex20ins occurred significantly and exclusively with certain driver genes in LUAD, including fusion (χ=7.133, P=0.008), (χ=8.468, P=0.004), and (χ=5.792, P=0.016). No gene was observed to be significantly co-mutated with ex20ins. In general, patients with ex20ins shared a similar age and gender to patients with other mutations or without ex20ins.

Conclusions: Overall, our results revealed the molecular and clinicopathologic features of ex20ins in Chinese LUAD patients, which will be helpful for drug development and in clinical trials targeting ex20ins.